sign in sign up
<<
Home , Chyluria, Renal colic, Trigonitis, Ureteritis, Vesicoureteral reflux

Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

190.12 - Culture, Bacterial

Other Names/Abbreviations Urine culture Description A bacterial urine culture is a laboratory test service performed on a urine specimen to establish the probable etiology of a presumed . It is common practice to do a urinalysis prior to a urine culture. A urine culture for bacteria might also be used as part of the evaluation and management of another related condition. The procedure includes aerobic agar-based isolation of bacteria or other cultivable organisms present, and quantitation of types present based on morphologic criteria. Isolates deemed significant may be subjected to additional identification and susceptibility procedures as requested by the ordering physician. The physician’s request may be through clearly documented and communicated laboratory protocols. HCPCS Codes (Alphanumeric, CPT AMA) Code Description 87086 Culture, bacterial; quantitative, colony count, urine. Culture, bacterial; with isolation and presumptive identification of each 87088 isolates, urine.

ICD-10-CM Codes Covered by Medicare Program

The ICD-10-CM codes in the table below can be viewed on CMS’ website as part of Downloads: Lab Code List, at http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

Code Description A02.1 Salmonella sepsis A18.14 Tuberculosis of prostate A34 Obstetrical tetanus A40.0 Sepsis due to streptococcus, group A A40.1 Sepsis due to streptococcus, group B A40.3 Sepsis due to Streptococcus pneumoniae A40.8 Other streptococcal sepsis A40.9 Streptococcal sepsis, unspecified A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus A41.1 Sepsis due to other specified staphylococcus

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 15 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description A41.2 Sepsis due to unspecified staphylococcus A41.3 Sepsis due to Hemophilus influenzae A41.4 Sepsis due to anaerobes A41.50 Gram-negative sepsis, unspecified A41.51 Sepsis due to Escherichia coli [E. coli] A41.52 Sepsis due to Pseudomonas A41.53 Sepsis due to Serratia A41.59 Other Gram-negative sepsis A41.81 Sepsis due to Enterococcus A41.89 Other specified sepsis A41.9 Sepsis, unspecified organism A42.7 Actinomycotic sepsis A56.01 Chlamydial cystitis and A56.02 Chlamydial vulvovaginitis A56.11 Chlamydial female pelvic inflammatory disease D65 Disseminated intravascular coagulation [defibrination syndrome] D70.0 Congenital agranulocytosis D70.1 Agranulocytosis secondary to cancer chemotherapy D70.2 Other drug-induced agranulocytosis D70.3 Neutropenia due to infection D70.4 Cyclic neutropenia D70.8 Other neutropenia D70.9 Neutropenia, unspecified D72.89 Other specified disorders of white blood cells E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic disease E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication E11.10 Type 2 diabetes mellitus with ketoacidosis without coma E11.11 Type 2 diabetes mellitus with ketoacidosis with coma E87.2 Acidosis E87.4 Mixed disorder of acid-base balance F45.8 Other somatoform disorders G93.3 Postviral fatigue syndrome I50.814 Right heart failure due to left heart failure

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 16 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description I50.82 Biventricular heart failure I50.84 End stage heart failure I50.89 Other heart failure J80 Acute respiratory distress syndrome K72.00 Acute and subacute hepatic failure without coma K72.01 Acute and subacute hepatic failure with coma K76.2 Central hemorrhagic necrosis of liver M04.1 Periodic syndromes M32.14 Glomerular disease in systemic lupus erythematosus M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus M35.04 Sicca syndrome with tubulo-interstitial nephropathy M54.89 Other dorsalgia M54.9 Dorsalgia, unspecified N00.0 Acute nephritic syndrome with minor glomerular abnormality N00.1 Acute nephritic syndrome with focal and segmental glomerular lesions N00.2 Acute nephritic syndrome with diffuse membranous glomerulonephritis N00.3 Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N00.4 Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N00.5 Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N00.6 Acute nephritic syndrome with dense deposit disease N00.7 Acute nephritic syndrome with diffuse crescentic glomerulonephritis N00.8 Acute nephritic syndrome with other morphologic changes N00.9 Acute nephritic syndrome with unspecified morphologic changes N01.0 Rapidly progressive nephritic syndrome with minor glomerular abnormality N01.1 Rapidly progressive nephritic syndrome with focal and segmental glomerular lesions N01.2 Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis N01.3 Rapidly progressive nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N01.4 Rapidly progressive nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N01.5 Rapidly progressive nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N01.6 Rapidly progressive nephritic syndrome with dense deposit disease N01.7 Rapidly progressive nephritic syndrome with diffuse crescentic glomerulonephritis N01.8 Rapidly progressive nephritic syndrome with other morphologic changes

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 17 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N01.9 Rapidly progressive nephritic syndrome with unspecified morphologic changes N05.0 Unspecified nephritic syndrome with minor glomerular abnormality N05.1 Unspecified nephritic syndrome with focal and segmental glomerular lesions N05.2 Unspecified nephritic syndrome with diffuse membranous glomerulonephritis N05.3 Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N05.4 Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N05.5 Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N05.6 Unspecified nephritic syndrome with dense deposit disease N05.7 Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis N05.8 Unspecified nephritic syndrome with other morphologic changes N05.9 Unspecified nephritic syndrome with unspecified morphologic changes N06.0 Isolated with minor glomerular abnormality N06.1 Isolated proteinuria with focal and segmental glomerular lesions N06.2 Isolated proteinuria with diffuse membranous glomerulonephritis N06.3 Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis N06.4 Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis N06.5 Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis N06.6 Isolated proteinuria with dense deposit disease N06.7 Isolated proteinuria with diffuse crescentic glomerulonephritis N06.8 Isolated proteinuria with other morphologic lesion N06.9 Isolated proteinuria with unspecified morphologic lesion N07.0 Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality N07.1 Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions N07.2 Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis N07.3 Hereditary nephropathy, not elsewhere classified with diffuse mesangial proliferative glomerulonephritis N07.4 Hereditary nephropathy, not elsewhere classified with diffuse endocapillary proliferative glomerulonephritis N07.5 Hereditary nephropathy, not elsewhere classified with diffuse mesangiocapillary glomerulonephritis N07.6 Hereditary nephropathy, not elsewhere classified with dense deposit disease N07.7 Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis N07.8 Hereditary nephropathy, not elsewhere classified with other morphologic lesions

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 18 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N07.9 Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions N08 Glomerular disorders in diseases classified elsewhere N10 Acute N11.0 Nonobstructive reflux-associated chronic pyelonephritis N11.1 Chronic obstructive pyelonephritis N11.8 Other chronic tubulo-interstitial nephritis N11.9 Chronic tubulo-interstitial nephritis, unspecified N12 Tubulo-interstitial nephritis, not specified as acute or chronic N13.0 with ureteropelvic junction obstruction N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified N13.2 Hydronephrosis with renal and ureteral calculous obstruction N13.4 Hydroureter N13.5 Crossing vessel and stricture of without hydronephrosis N13.6 Pyonephrosis N13.70 Vesicoureteral-reflux, unspecified N13.71 Vesicoureteral-reflux without N13.721 Vesicoureteral-reflux with reflux nephropathy without hydroureter, unilateral N13.722 Vesicoureteral-reflux with reflux nephropathy without hydroureter, bilateral N13.729 Vesicoureteral-reflux with reflux nephropathy without hydroureter, unspecified N13.731 Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral N13.732 Vesicoureteral-reflux with reflux nephropathy with hydroureter, bilateral N13.739 Vesicoureteral-reflux with reflux nephropathy with hydroureter, unspecified N13.8 Other obstructive and reflux uropathy N13.9 Obstructive and reflux uropathy, unspecified N14.0 nephropathy N14.1 Nephropathy induced by other drugs, medicaments and biological substances N14.2 Nephropathy induced by unspecified drug, medicament or biological substance N14.3 Nephropathy induced by heavy metals N14.4 Toxic nephropathy, not elsewhere classified N15.0 Balkan nephropathy N15.1 Renal and perinephric abscess N15.8 Other specified renal tubulo-interstitial diseases N15.9 Renal tubulo-interstitial disease, unspecified N16 Renal tubulo-interstitial disorders in diseases classified elsewhere

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 19 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N17.1 Acute kidney failure with acute cortical necrosis N17.2 Acute kidney failure with medullary necrosis N18.6 End stage renal disease N20.0 Calculus of kidney N20.1 Calculus of ureter N20.2 Calculus of kidney with calculus of ureter N20.9 Urinary calculus, unspecified N21.0 Calculus in bladder N21.1 Calculus in N21.8 Other lower urinary tract calculus N21.9 Calculus of lower urinary tract, unspecified N22 Calculus of urinary tract in diseases classified elsewhere N23 Unspecified renal N28.0 Ischemia and infarction of kidney N28.1 Cyst of kidney, acquired N28.81 Hypertrophy of kidney N28.82 Megaloureter N28.83 Nephroptosis N28.84 Pyelitis cystica N28.85 Pyeloureteritis cystica N28.86 cystica N28.89 Other specified disorders of kidney and ureter N28.9 Disorder of kidney and ureter, unspecified N29 Other disorders of kidney and ureter in diseases classified elsewhere N30.00 Acute cystitis without N30.01 Acute cystitis with hematuria N30.10 (chronic) without hematuria N30.11 Interstitial cystitis (chronic) with hematuria N30.20 Other chronic cystitis without hematuria N30.21 Other chronic cystitis with hematuria N30.30 without hematuria N30.31 Trigonitis with hematuria N30.40 Irradiation cystitis without hematuria N30.41 Irradiation cystitis with hematuria

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 20 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N30.80 Other cystitis without hematuria N30.81 Other cystitis with hematuria N30.90 Cystitis, unspecified without hematuria N30.91 Cystitis, unspecified with hematuria N34.0 Urethral abscess N34.1 Nonspecific urethritis N34.2 Other urethritis N34.3 , unspecified *N35.016 *Post-traumatic , male, overlapping sites N35.111 Postinfective urethral stricture, not elsewhere classified, male, meatal N35.112 Postinfective bulbous urethral stricture, not elsewhere classified, male N35.113 Postinfective membranous urethral stricture, not elsewhere classified, male N35.114 Postinfective anterior urethral stricture, not elsewhere classified, male *N35.116 *Postinfective urethral stricture, not elsewhere classified, male, overlapping sites N35.119 Postinfective urethral stricture, not elsewhere classified, male, unspecified N35.12 Postinfective urethral stricture, not elsewhere classified, female N37 Urethral disorders in diseases classified elsewhere N39.0 Urinary tract infection, site not specified N39.3 (female) (male) N39.41 Urge incontinence N39.42 Incontinence without sensory awareness N39.43 Post-void dribbling N39.44 Nocturnal N39.45 Continuous leakage N39.46 Mixed incontinence N39.490 N39.491 Coital incontinence N39.492 Postural (urinary) incontinence N39.498 Other specified N40.0 Benign prostatic hyperplasia without lower urinary tract symptoms N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms N40.2 Nodular prostate without lower urinary tract symptoms N40.3 Nodular prostate with lower urinary tract symptoms N41.0 Acute prostatitis

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 21 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N41.1 Chronic prostatitis N41.2 Abscess of prostate N41.3 Prostatocystitis N41.4 Granulomatous prostatitis N41.8 Other inflammatory diseases of prostate N41.9 Inflammatory disease of prostate, unspecified N42.0 Calculus of prostate N42.1 Congestion and hemorrhage of prostate N42.30 Unspecified dysplasia of prostate N42.31 Prostatic intraepithelial neoplasia N42.32 Atypical small acinar proliferation of prostate N42.39 Other dysplasia of prostate N42.81 Prostatodynia syndrome N42.82 Prostatosis syndrome N42.83 Cyst of prostate N42.89 Other specified disorders of prostate N42.9 Disorder of prostate, unspecified N43.40 Spermatocele of epididymis, unspecified N43.41 Spermatocele of epididymis, single N43.42 Spermatocele of epididymis, multiple N44.00 Torsion of testis, unspecified N44.01 Extravaginal torsion of spermatic cord N44.02 Intravaginal torsion of spermatic cord N44.03 Torsion of appendix testis N44.04 Torsion of appendix epididymis N44.1 Cyst of tunica albuginea testis N44.2 Benign cyst of testis N44.8 Other noninflammatory disorders of the testis N45.1 Epididymitis N45.2 Orchitis N45.3 Epididymo-orchitis N45.4 Abscess of epididymis or testis N49.0 Inflammatory disorders of seminal vesicle N49.1 Inflammatory disorders of spermatic cord, tunica vaginalis and vas deferens

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 22 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N49.2 Inflammatory disorders of scrotum N49.3 Fournier gangrene N49.8 Inflammatory disorders of other specified male genital organs N49.9 Inflammatory disorder of unspecified male genital organ N50.0 Atrophy of testis N50.1 Vascular disorders of male genital organs N50.3 Cyst of epididymis N50.811 Right testicular pain N50.812 Left testicular pain N50.819 Testicular pain, unspecified N50.82 Scrotal pain N50.89 Other specified disorders of the male genital organs N50.9 Disorder of male genital organs, unspecified N51 Disorders of male genital organs in diseases classified elsewhere N53.11 Retarded ejaculation N53.12 Painful ejaculation N53.13 Anejaculatory orgasm N53.14 Retrograde ejaculation N53.19 Other ejaculatory dysfunction N53.8 Other male sexual dysfunction N53.9 Unspecified male sexual dysfunction N70.01 Acute salpingitis N70.02 Acute oophoritis N70.03 Acute salpingitis and oophoritis N70.11 Chronic salpingitis N70.12 Chronic oophoritis N70.13 Chronic salpingitis and oophoritis N70.91 Salpingitis, unspecified N70.92 Oophoritis, unspecified N70.93 Salpingitis and oophoritis, unspecified N71.0 Acute inflammatory disease of uterus N71.1 Chronic inflammatory disease of uterus N71.9 Inflammatory disease of uterus, unspecified N72 Inflammatory disease of cervix uteri

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 23 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N73.0 Acute parametritis and pelvic cellulitis N73.1 Chronic parametritis and pelvic cellulitis N73.2 Unspecified parametritis and pelvic cellulitis N73.3 Female acute pelvic N73.4 Female chronic pelvic peritonitis N73.5 Female pelvic peritonitis, unspecified N73.6 Female pelvic peritoneal adhesions (postinfective) N73.8 Other specified female pelvic inflammatory diseases N73.9 Female pelvic inflammatory disease, unspecified N74 Female pelvic inflammatory disorders in diseases classified elsewhere N75.0 Cyst of Bartholin's gland N75.1 Abscess of Bartholin's gland N75.8 Other diseases of Bartholin's gland N75.9 Disease of Bartholin's gland, unspecified N76.0 Acute vaginitis N76.1 Subacute and chronic vaginitis N76.2 Acute vulvitis N76.3 Subacute and chronic vulvitis N76.4 Abscess of vulva N76.5 Ulceration of vagina N76.6 Ulceration of vulva N76.81 Mucositis (ulcerative) of vagina and vulva N76.89 Other specified of vagina and vulva N77.0 Ulceration of vulva in diseases classified elsewhere N77.1 Vaginitis, vulvitis and vulvovaginitis in diseases classified elsewhere N82.0 Vesicovaginal fistula N82.1 Other female urinary-genital tract fistulae N82.2 Fistula of vagina to small intestine N82.3 Fistula of vagina to large intestine N82.4 Other female intestinal-genital tract fistulae N82.5 Female genital tract-skin fistulae N82.8 Other female genital tract fistulae N82.9 Female genital tract fistula, unspecified N83.511 Torsion of right ovary and ovarian pedicle

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 24 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description N83.512 Torsion of left ovary and ovarian pedicle N83.519 Torsion of ovary and ovarian pedicle, unspecified side N83.521 Torsion of right fallopian tube N83.522 Torsion of left fallopian tube N83.529 Torsion of fallopian tube, unspecified side N99.115 Postprocedural fossa navicularis urethral stricture *N99.116 *Postprocedural urethral stricture, male, overlapping sites N99.523 Herniation of incontinent stoma of urinary tract N99.524 Stenosis of incontinent stoma of urinary tract N99.533 Herniation of continent stoma of urinary tract N99.534 Stenosis of continent stoma of urinary tract O08.0 Genital tract and pelvic infection following ectopic and molar pregnancy O08.3 Shock following ectopic and molar pregnancy O08.82 Sepsis following ectopic and molar pregnancy O12.04 Gestational edema, complicating childbirth O12.05 Gestational edema, complicating the puerperium O12.14 Gestational proteinuria, complicating childbirth O12.15 Gestational proteinuria, complicating the puerperium O12.24 Gestational edema with proteinuria, complicating childbirth O12.25 Gestational edema with proteinuria, complicating the puerperium O13.4 Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating childbirth O13.5 Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating the puerperium O14.04 Mild to moderate pre-eclampsia, complicating childbirth O14.05 Mild to moderate pre-eclampsia, complicating the puerperium O14.14 Severe pre-eclampsia complicating childbirth O14.15 Severe pre-eclampsia, complicating the puerperium O14.24 HELLP syndrome, complicating childbirth O14.25 HELLP syndrome, complicating the puerperium O14.94 Unspecified pre-eclampsia, complicating childbirth O14.95 Unspecified pre-eclampsia, complicating the puerperium O16.4 Unspecified maternal hypertension, complicating childbirth O16.5 Unspecified maternal hypertension, complicating the puerperium

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 25 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description O23.00 Infections of kidney in pregnancy, unspecified trimester O23.01 Infections of kidney in pregnancy, first trimester O23.02 Infections of kidney in pregnancy, second trimester O23.03 Infections of kidney in pregnancy, third trimester O23.10 Infections of bladder in pregnancy, unspecified trimester O23.11 Infections of bladder in pregnancy, first trimester O23.12 Infections of bladder in pregnancy, second trimester O23.13 Infections of bladder in pregnancy, third trimester O23.20 Infections of urethra in pregnancy, unspecified trimester O23.21 Infections of urethra in pregnancy, first trimester O23.22 Infections of urethra in pregnancy, second trimester O23.23 Infections of urethra in pregnancy, third trimester O23.30 Infections of other parts of urinary tract in pregnancy, unspecified trimester O23.31 Infections of other parts of urinary tract in pregnancy, first trimester O23.32 Infections of other parts of urinary tract in pregnancy, second trimester O23.33 Infections of other parts of urinary tract in pregnancy, third trimester O23.40 Unspecified infection of urinary tract in pregnancy, unspecified trimester O23.41 Unspecified infection of urinary tract in pregnancy, first trimester O23.42 Unspecified infection of urinary tract in pregnancy, second trimester O23.43 Unspecified infection of urinary tract in pregnancy, third trimester O23.511 Infections of cervix in pregnancy, first trimester O23.512 Infections of cervix in pregnancy, second trimester O23.513 Infections of cervix in pregnancy, third trimester O23.519 Infections of cervix in pregnancy, unspecified trimester O23.521 Salpingo-oophoritis in pregnancy, first trimester O23.522 Salpingo-oophoritis in pregnancy, second trimester O23.523 Salpingo-oophoritis in pregnancy, third trimester O23.529 Salpingo-oophoritis in pregnancy, unspecified trimester O23.591 Infection of other part of genital tract in pregnancy, first trimester O23.592 Infection of other part of genital tract in pregnancy, second trimester O23.593 Infection of other part of genital tract in pregnancy, third trimester O23.599 Infection of other part of genital tract in pregnancy, unspecified trimester O23.90 Unspecified genitourinary tract infection in pregnancy, unspecified trimester O23.91 Unspecified genitourinary tract infection in pregnancy, first trimester

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 26 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description O23.92 Unspecified genitourinary tract infection in pregnancy, second trimester O23.93 Unspecified genitourinary tract infection in pregnancy, third trimester O24.415 Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs O24.425 Gestational diabetes mellitus in childbirth, controlled by oral hypoglycemic drugs O24.435 Gestational diabetes mellitus in puerperium, controlled by oral hypoglycemic drugs O33.7XX0 Maternal care for disproportion due to other fetal deformities, not applicable or unspecified O33.7XX1 Maternal care for disproportion due to other fetal deformities, fetus 1 O33.7XX2 Maternal care for disproportion due to other fetal deformities, fetus 2 O33.7XX3 Maternal care for disproportion due to other fetal deformities, fetus 3 O33.7XX4 Maternal care for disproportion due to other fetal deformities, fetus 4 O33.7XX5 Maternal care for disproportion due to other fetal deformities, fetus 5 O33.7XX9 Maternal care for disproportion due to other fetal deformities, other fetus O36.8310 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, not applicable or unspecified O36.8311 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 1 O36.8312 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 2 O36.8313 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 3 O36.8314 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 4 O36.8315 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 5 O36.8319 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, other fetus O36.8320 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, not applicable or unspecified O36.8321 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 1 O36.8322 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 2 O36.8323 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 3 O36.8324 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 4 O36.8325 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 5 O36.8329 Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, other fetus O36.8330 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, not applicable or unspecified O36.8331 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 1 O36.8332 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 2 O36.8333 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 3 O36.8334 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 4

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 27 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description O36.8335 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 5 O36.8339 Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, other fetus O36.8390 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, not applicable or unspecified O36.8391 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 1 O36.8392 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 2 O36.8393 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 3 O36.8394 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 4 O36.8395 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 5 O36.8399 Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, other fetus O44.20 Partial placenta previa NOS or without hemorrhage, unspecified trimester O44.21 Partial placenta previa NOS or without hemorrhage, first trimester O44.22 Partial placenta previa NOS or without hemorrhage, second trimester O44.23 Partial placenta previa NOS or without hemorrhage, third trimester O44.30 Partial placenta previa with hemorrhage, unspecified trimester O44.31 Partial placenta previa with hemorrhage, first trimester O44.32 Partial placenta previa with hemorrhage, second trimester O44.33 Partial placenta previa with hemorrhage, third trimester O44.40 Low lying placenta NOS or without hemorrhage, unspecified trimester O44.41 Low lying placenta NOS or without hemorrhage, first trimester O44.42 Low lying placenta NOS or without hemorrhage, second trimester O44.43 Low lying placenta NOS or without hemorrhage, third trimester O44.50 Low lying placenta with hemorrhage, unspecified trimester O44.51 Low lying placenta with hemorrhage, first trimester O44.52 Low lying placenta with hemorrhage, second trimester O44.53 Low lying placenta with hemorrhage, third trimester O85 Puerperal sepsis O86.11 Cervicitis following delivery O86.12 Endometritis following delivery O86.13 Vaginitis following delivery

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 28 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description O86.19 Other infection of genital tract following delivery O86.20 Urinary tract infection following delivery, unspecified O86.21 Infection of kidney following delivery O86.22 Infection of bladder following delivery O86.29 Other urinary tract infection following delivery O86.4 Pyrexia of unknown origin following delivery O86.81 Puerperal septic thrombophlebitis O86.89 Other specified puerperal infections P36.0 Sepsis of newborn due to streptococcus, group B P36.10 Sepsis of newborn due to unspecified streptococci P36.19 Sepsis of newborn due to other streptococci P36.2 Sepsis of newborn due to Staphylococcus aureus P36.30 Sepsis of newborn due to unspecified staphylococci P36.39 Sepsis of newborn due to other staphylococci P36.4 Sepsis of newborn due to Escherichia coli P36.5 Sepsis of newborn due to anaerobes P36.8 Other bacterial sepsis of newborn P36.9 Bacterial sepsis of newborn, unspecified P39.3 Neonatal urinary tract infection R00.0 Tachycardia, unspecified R10.0 Acute abdomen R10.10 Upper , unspecified R10.11 Right upper quadrant pain R10.12 Left upper quadrant pain R10.13 Epigastric pain R10.2 Pelvic and perineal pain R10.30 Lower abdominal pain, unspecified R10.31 Right lower quadrant pain R10.32 Left lower quadrant pain R10.33 Periumbilical pain R10.811 Right upper quadrant abdominal tenderness R10.812 Left upper quadrant abdominal tenderness R10.813 Right lower quadrant abdominal tenderness R10.814 Left lower quadrant abdominal tenderness

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 29 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description R10.815 Periumbilic abdominal tenderness R10.816 Epigastric abdominal tenderness R10.817 Generalized abdominal tenderness R10.819 Abdominal tenderness, unspecified site R10.821 Right upper quadrant rebound abdominal tenderness R10.822 Left upper quadrant rebound abdominal tenderness R10.823 Right lower quadrant rebound abdominal tenderness R10.824 Left lower quadrant rebound abdominal tenderness R10.825 Periumbilic rebound abdominal tenderness R10.826 Epigastric rebound abdominal tenderness R10.827 Generalized rebound abdominal tenderness R10.829 Rebound abdominal tenderness, unspecified site R10.83 Colic R10.84 Generalized abdominal pain R10.9 Unspecified abdominal pain R30.0 R30.1 R30.9 Painful micturition, unspecified R31.0 Gross hematuria R31.1 Benign essential microscopic hematuria R31.21 Asymptomatic microscopic hematuria R31.29 Other microscopic hematuria R31.9 Hematuria, unspecified R32 Unspecified urinary incontinence R33.0 Drug induced retention of urine R33.8 Other retention of urine R33.9 Retention of urine, unspecified R34 and R35.0 Frequency of micturition R35.1 R35.8 Other R36.0 Urethral discharge without blood R36.1 Hematospermia R36.9 Urethral discharge, unspecified

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 30 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description R39.0 R39.11 Hesitancy of micturition R39.12 Poor urinary stream R39.13 Splitting of urinary stream R39.14 Feeling of incomplete bladder emptying R39.15 Urgency of urination R39.16 Straining to void R39.191 Need to immediately re-void R39.192 Position dependent micturition R39.198 Other difficulties with micturition R39.2 Extrarenal R39.81 Functional urinary incontinence R39.82 Chronic bladder pain R39.89 Other symptoms and signs involving the genitourinary system R39.9 Unspecified symptoms and signs involving the genitourinary system R40.2410 Glasgow coma scale score 13-15, unspecified time R40.2411 Glasgow coma scale score 13-15, in the field [EMT or ambulance] R40.2412 Glasgow coma scale score 13-15, at arrival to emergency department R40.2413 Glasgow coma scale score 13-15, at hospital admission R40.2414 Glasgow coma scale score 13-15, 24 hours or more after hospital admission R40.2420 Glasgow coma scale score 9-12, unspecified time R40.2421 Glasgow coma scale score 9-12, in the field [EMT or ambulance] R40.2422 Glasgow coma scale score 9-12, at arrival to emergency department R40.2423 Glasgow coma scale score 9-12, at hospital admission R40.2424 Glasgow coma scale score 9-12, 24 hours or more after hospital admission R40.2430 Glasgow coma scale score 3-8, unspecified time R40.2431 Glasgow coma scale score 3-8, in the field [EMT or ambulance] R40.2432 Glasgow coma scale score 3-8, at arrival to emergency department R40.2433 Glasgow coma scale score 3-8, at hospital admission R40.2434 Glasgow coma scale score 3-8, 24 hours or more after hospital admission R40.2440 Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time R40.2441 Other coma, without documented Glasgow coma scale score, or with partial score reported, in the field [EMT or ambulance]

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 31 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description R40.2442 Other coma, without documented Glasgow coma scale score, or with partial score reported, at arrival to emergency department R40.2443 Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission R40.2444 Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission R40.4 Transient alteration of awareness R41.0 Disorientation, unspecified R41.1 Anterograde amnesia R41.2 Retrograde amnesia R41.3 Other amnesia R41.82 Altered mental status, unspecified R41.9 Unspecified symptoms and signs involving cognitive functions and awareness R45.84 Anhedonia R50.2 Drug induced fever R50.81 Fever presenting with conditions classified elsewhere R50.82 Postprocedural fever R50.83 Postvaccination fever R50.84 Febrile nonhemolytic transfusion reaction R50.9 Fever, unspecified R52 Pain, unspecified R53.0 Neoplastic (malignant) related fatigue R53.1 Weakness R53.81 Other malaise R53.83 Other fatigue R57.0 Cardiogenic shock R57.1 Hypovolemic shock R57.8 Other shock R57.9 Shock, unspecified R65.21 Severe sepsis with septic shock R68.0 Hypothermia, not associated with low environmental temperature R68.81 Early satiety R68.83 Chills (without fever) R68.89 Other general symptoms and signs R73.03 Prediabetes

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 32 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description R78.81 Bacteremia R80.0 Isolated proteinuria R80.1 Persistent proteinuria, unspecified R80.2 Orthostatic proteinuria, unspecified R80.3 Bence Jones proteinuria R80.8 Other proteinuria R80.9 Proteinuria, unspecified R81 R82.0 Chyluria R82.1 R82.2 Biliuria R82.3 R82.4 Acetonuria R82.5 Elevated urine levels of drugs, medicaments and biological substances R82.6 Abnormal urine levels of substances chiefly nonmedicinal as to source R82.71 R82.79 Other abnormal findings on microbiological examination of urine R82.8 Abnormal findings on cytological and histological examination of urine R82.90 Unspecified abnormal findings in urine R82.91 Other chromoabnormalities of urine R82.991 Hypocitraturia R82.992 R82.993 Hyperuricoscuria R82.994 Hypercalciuria R82.998 Other abnormal findings in urine T19.0XXA Foreign body in urethra, initial encounter T19.1XXA Foreign body in bladder, initial encounter T19.4XXA Foreign body in penis, initial encounter T83.011A Breakdown (mechanical) of indwelling urethral catheter, initial encounter T83.011D Breakdown (mechanical) of indwelling urethral catheter, subsequent encounter T83.011S Breakdown (mechanical) of indwelling urethral catheter, sequela T83.012A Breakdown (mechanical) of nephrostomy catheter, initial encounter T83.012D Breakdown (mechanical) of nephrostomy catheter, subsequent encounter T83.012S Breakdown (mechanical) of nephrostomy catheter, sequela

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 33 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description T83.021A Displacement of indwelling urethral catheter, initial encounter T83.021D Displacement of indwelling urethral catheter, subsequent encounter T83.021S Displacement of indwelling urethral catheter, sequela T83.022A Displacement of nephrostomy catheter, initial encounter T83.022D Displacement of nephrostomy catheter, subsequent encounter T83.022S Displacement of nephrostomy catheter, sequela T83.031A Leakage of indwelling urethral catheter, initial encounter T83.031D Leakage of indwelling urethral catheter, subsequent encounter T83.031S Leakage of indwelling urethral catheter, sequela T83.032A Leakage of nephrostomy catheter, initial encounter T83.032D Leakage of nephrostomy catheter, subsequent encounter T83.032S Leakage of nephrostomy catheter, sequela T83.091A Other mechanical complication of indwelling urethral catheter, initial encounter T83.091D Other mechanical complication of indwelling urethral catheter, subsequent encounter T83.091S Other mechanical complication of indwelling urethral catheter, sequela T83.092A Other mechanical complication of nephrostomy catheter, initial encounter T83.092D Other mechanical complication of nephrostomy catheter, subsequent encounter T83.092S Other mechanical complication of nephrostomy catheter, sequela T83.113A Breakdown (mechanical) of other urinary stents, initial encounter T83.113D Breakdown (mechanical) of other urinary stents, subsequent encounter T83.113S Breakdown (mechanical) of other urinary stents, sequela T83.123A Displacement of other urinary stents, initial encounter T83.123D Displacement of other urinary stents, subsequent encounter T83.123S Displacement of other urinary stents, sequela T83.193A Other mechanical complication of other urinary stent, initial encounter T83.193D Other mechanical complication of other urinary stent, subsequent encounter T83.193S Other mechanical complication of other urinary stent, sequela T83.24XA Erosion of graft of urinary organ, initial encounter T83.24XD Erosion of graft of urinary organ, subsequent encounter T83.24XS Erosion of graft of urinary organ, sequela T83.25XA Exposure of graft of urinary organ, initial encounter T83.25XD Exposure of graft of urinary organ, subsequent encounter T83.25XS Exposure of graft of urinary organ, sequela T83.510A Infection and inflammatory reaction due to cystostomy catheter, initial encounter

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 34 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description T83.510D Infection and inflammatory reaction due to cystostomy catheter, subsequent encounter T83.510S Infection and inflammatory reaction due to cystostomy catheter, sequela T83.511A Infection and inflammatory reaction due to indwelling urethral catheter, initial encounter T83.511D Infection and inflammatory reaction due to indwelling urethral catheter, subsequent encounter T83.511S Infection and inflammatory reaction due to indwelling urethral catheter, sequela T83.512A Infection and inflammatory reaction due to nephrostomy catheter, initial encounter T83.512D Infection and inflammatory reaction due to nephrostomy catheter, subsequent encounter T83.512S Infection and inflammatory reaction due to nephrostomy catheter, sequela T83.518A Infection and inflammatory reaction due to other urinary catheter, initial encounter T83.518D Infection and inflammatory reaction due to other urinary catheter, subsequent encounter T83.518S Infection and inflammatory reaction due to other urinary catheter, sequela T83.590A Infection and inflammatory reaction due to implanted urinary neurostimulation device, initial encounter T83.590D Infection and inflammatory reaction due to implanted urinary neurostimulation device, subsequent encounter T83.590S Infection and inflammatory reaction due to implanted urinary neurostimulation device, sequela T83.591A Infection and inflammatory reaction due to implanted urinary sphincter, initial encounter T83.591D Infection and inflammatory reaction due to implanted urinary sphincter, subsequent encounter T83.591S Infection and inflammatory reaction due to implanted urinary sphincter, sequela T83.592A Infection and inflammatory reaction due to indwelling ureteral stent, initial encounter T83.592D Infection and inflammatory reaction due to indwelling ureteral stent, subsequent encounter T83.592S Infection and inflammatory reaction due to indwelling ureteral stent, sequela T83.593A Infection and inflammatory reaction due to other urinary stents, initial encounter T83.593D Infection and inflammatory reaction due to other urinary stents, subsequent encounter T83.593S Infection and inflammatory reaction due to other urinary stents, sequela T83.598A Infection and inflammatory reaction due to other prosthetic device, implant and graft in , initial encounter T83.598D Infection and inflammatory reaction due to other prosthetic device, implant and graft in urinary system, subsequent encounter T83.598S Infection and inflammatory reaction due to other prosthetic device, implant and graft in urinary system, sequela T83.61XA Infection and inflammatory reaction due to implanted penile prosthesis, initial encounter T83.61XD Infection and inflammatory reaction due to implanted penile prosthesis, subsequent encounter

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 35 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description T83.61XS Infection and inflammatory reaction due to implanted penile prosthesis, sequela T83.62XA Infection and inflammatory reaction due to implanted testicular prosthesis, initial encounter T83.62XD Infection and inflammatory reaction due to implanted testicular prosthesis, subsequent encounter T83.62XS Infection and inflammatory reaction due to implanted testicular prosthesis, sequela T83.69XA Infection and inflammatory reaction due to other prosthetic device, implant and graft in genital tract, initial encounter T83.69XD Infection and inflammatory reaction due to other prosthetic device, implant and graft in genital tract, subsequent encounter T83.69XS Infection and inflammatory reaction due to other prosthetic device, implant and graft in genital tract, sequela T83.712A Erosion of implanted urethral mesh to surrounding organ or tissue, initial encounter T83.712D Erosion of implanted urethral mesh to surrounding organ or tissue, subsequent encounter T83.712S Erosion of implanted urethral mesh to surrounding organ or tissue, sequela T83.713A Erosion of implanted urethral bulking agent to surrounding organ or tissue, initial encounter T83.713D Erosion of implanted urethral bulking agent to surrounding organ or tissue, subsequent encounter T83.713S Erosion of implanted urethral bulking agent to surrounding organ or tissue, sequela T83.714A Erosion of implanted ureteral bulking agent to surrounding organ or tissue, initial encounter T83.714D Erosion of implanted ureteral bulking agent to surrounding organ or tissue, subsequent encounter T83.714S Erosion of implanted ureteral bulking agent to surrounding organ or tissue, sequela T83.719A Erosion of other prosthetic materials to surrounding organ or tissue, initial encounter T83.719D Erosion of other prosthetic materials to surrounding organ or tissue, subsequent encounter T83.719S Erosion of other prosthetic materials to surrounding organ or tissue, sequela T83.722A Exposure of implanted urethral mesh into urethra, initial encounter T83.722D Exposure of implanted urethral mesh into urethra, subsequent encounter T83.722S Exposure of implanted urethral mesh into urethra, sequela T83.723A Exposure of implanted urethral bulking agent into urethra, initial encounter T83.723D Exposure of implanted urethral bulking agent into urethra, subsequent encounter T83.723S Exposure of implanted urethral bulking agent into urethra, sequela T83.724A Exposure of implanted ureteral bulking agent into ureter, initial encounter T83.724D Exposure of implanted ureteral bulking agent into ureter, subsequent encounter T83.724S Exposure of implanted ureteral bulking agent into ureter, sequela T83.79XA Other specified complications due to other genitourinary prosthetic materials, initial encounter

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 36 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Code Description T83.79XD Other specified complications due to other genitourinary prosthetic materials, subsequent encounter T83.79XS Other specified complications due to other genitourinary prosthetic materials, sequela Z05.0 Observation and evaluation of newborn for suspected cardiac condition ruled out Z05.1 Observation and evaluation of newborn for suspected infectious condition ruled out Z05.2 Observation and evaluation of newborn for suspected neurological condition ruled out Z05.3 Observation and evaluation of newborn for suspected respiratory condition ruled out Z05.41 Observation and evaluation of newborn for suspected genetic condition ruled out Z05.42 Observation and evaluation of newborn for suspected metabolic condition ruled out Z05.43 Observation and evaluation of newborn for suspected immunologic condition ruled out Z05.5 Observation and evaluation of newborn for suspected gastrointestinal condition ruled out Z05.6 Observation and evaluation of newborn for suspected genitourinary condition ruled out Z05.71 Observation and evaluation of newborn for suspected skin and subcutaneous tissue condition ruled out Z05.72 Observation and evaluation of newborn for suspected musculoskeletal condition ruled out Z05.73 Observation and evaluation of newborn for suspected connective tissue condition ruled out Z05.8 Observation and evaluation of newborn for other specified suspected condition ruled out Z05.9 Observation and evaluation of newborn for unspecified suspected condition ruled out Z19.1 Hormone sensitive malignancy status Z19.2 Hormone resistant malignancy status Z31.7 Encounter for procreative management and counseling for gestational carrier Z43.5 Encounter for attention to cystostomy Z43.6 Encounter for attention to other artificial openings of urinary tract Z79.3 Long term (current) use of hormonal contraceptives Z79.84 Long term (current) use of oral hypoglycemic drugs Z79.891 Long term (current) use of opiate analgesic Z79.899 Other long term (current) drug therapy Z84.82 Family history of sudden infant death syndrome Z93.50 Unspecified cystostomy status Z93.51 Cutaneous-vesicostomy status Z93.52 Appendico-vesicostomy status Z93.59 Other cystostomy status Z93.6 Other artificial openings of urinary tract status

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 37 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Indications 1. A beneficiary’s urinalysis is abnormal suggesting urinary tract infection, for example, abnormal microscopic (hematuria, pyuria, bacteriuria); abnormal biochemical urinalysis (positive , nitrite, protein, blood); a Gram’s stain positive for microorganisms; positive bacteriuria screen by a non-culture technique; or other significant abnormality of a urinalysis. While it is not essential to evaluate a urine specimen by one of these methods before a urine culture is performed, certain clinical presentations with highly suggestive may lend themselves to an antecedent urinalysis procedure where follow-up culture depends upon an initial positive or abnormal test result. 2. A beneficiary has clinical signs and symptoms indicative of a possible urinary tract infection (UTI). Acute lower UTI may present with urgency, frequency, nocturia, dysuria, discharge or incontinence. These findings might also be noted in upper UTI with additional systemic symptoms (for example, fever, chills, lethargy); or pain in the costovertebral, abdominal, or pelvic areas. Signs and symptoms might overlap considerably with other inflammatory conditions of the genitourinary tract (for example, prostatitis, urethritis, vaginitis, or cervicitis). Elderly or immunocompromised beneficiaries or those with neurologic disorders might present atypically (for example, general debility, acute mental status changes, declining functional status). 3. The beneficiary is being evaluated for suspected urosepsis, fever of unknown origin, or other systemic manifestations of infection but without a known source. Signs and symptoms used to define sepsis have been well established. 4. A test of cure is generally not indicated in an uncomplicated infection. However, it may be indicated if the beneficiary is being evaluated for response to therapy and there is a complicating co-existing urinary abnormality including structural or functional abnormalities, calculi, foreign bodies, or ureteral/renal stents or there is clinical or laboratory evidence of failure to respond as described in Indications 1 and 2. 5. In surgical procedures involving major manipulations of the genitourinary tract, preoperative examination to detect occult infection may be indicated in selected cases (for example, prior to renal transplantation, manipulation or removal of kidney stones, or transurethral of the bladder or prostate). 6. Urine culture may be indicated to detect occult infection in renal transplant recipients on immunosuppressive therapy. Limitations 1. CPT© code 87086 may be used one time per encounter. 2. Colony count restrictions on coverage of CPT© code 87088 do not apply as they may be highly variable according to syndrome or other clinical circumstances (for example, antecedent therapy, collection time, and degree of hydration). 3. CPT© code 87088 may be used multiple times in association with or independent of 87086, as urinary tract infections may be polymicrobial. 4. Testing for asymptomatic bacteriuria as part of a prenatal evaluation may be medically appropriate but is considered screening and therefore not covered by Medicare. The U.S. NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 38 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)

Preventive Services Task Force has concluded that screening for asymptomatic bacteriuria outside of the narrow indication for pregnant women is generally not indicated. There are insufficient data to recommend screening in ambulatory elderly beneficiaries including those with diabetes. Testing may be clinically indicated on other grounds including likelihood of recurrence or potential adverse effects of antibiotics, but is considered screening in the absence of clinical or laboratory evidence of infection. 5. To detect a clinically significant post-transplant occult infection in a renal allograft recipient on long-term immunosuppressive therapy, use code Z79.899. ICD-10-CM Codes That Do Not Support Medical Necessity Any ICD-10-CM code not listed in either of the ICD-10-CM covered or non-covered sections. Documentation Requirements Appropriate HCPCS/CPT© code(s) must be used as described. Sources of Information Bone, RC, RA Bal, FB Cerra, & ACCP/SCCM Consensus Conference Committee.1992. Definitions for sepsis & organ failure & guidelines for the use of innovative therapies in sepsis. Chest 101:1644-1655. Clarridge, JE, JR Johnson, and MT Pezzlo. 1998 (in press). Cumitech 2B: Laboratory Diagnosis of Urinary Tract Infections. AS Weissfeld (coor. ed.); ASM Press, Washington, DC. Kunin, CM. 1994. Urinary tract infections in females. Clin. Infect. Dis. 18:1-12. Sodeman, TM. 1995. A practical strategy for diagnosis of urinary tract infections. Clin. Lab. Med. 15:235-250. Stamm WE, and TM Hooton. 1993. Management of urinary tract infections in adults. N. Engl. J. Med. 329:1328-1334. United States Preventive Services Task Force (1996). Guidelines for screening for asymptomatic bacteriuria. Lachs MS, Nachamkin I, Edelstein PH et al. 1992. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann. Int. Med. 117:135-140

NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 39